Signs of cirrhosis on ultrasound
Liver cirrhosis is a very serious almost incurable disease. It is an actual medical problem in connection with the development of serious complications for the patient (portal hypertension and ascites). As far as an objective assessment of this pathological condition on the ultrasound, try to understand below.
It must be said that the most difficult diagnosis of early stages of development of this disease. According to statistics at that time to detect ultrasonic signs of cirrhosis only in 60-80% of cases.
Patient preparation for ultrasound scans
If you suspect cirrhosis of the liver ULTRASOUND investigation is recommended after the necessary training in the morning on an empty stomach. This should be deleted three days prior to the proposed study from the diet foods that can increase flatulence. With increased flatulence (presence of gas in the intestinal loops) recommended the use of means, helps to eliminate excess gas, for example , Drops one tablet 3 times a day, with the exception of the reception on the day of the survey.
If these methods do not help, then surveyed the day before your procedure requires bowel cleansing using enemas (1-2 enemas in the evening and 1 in the morning, not later than 3-4 hours before the ultrasound).
Technical features of the ULTRASOUND examination of the liver
Sonographic examination of the body is held in real time, while the patient must hold breath for breath. This technique facilitates better visualization of the liver for inspection. The ultrasonic sensor is first installed to the left of the navel, then moves in the umbilical region.
When liver ultrasound to assess the size of the body, its echostructure, arterial and venous blood flow, the condition of the intrahepatic bile ducts. Diplomaticheskie the study helps to identify changes in venous and arterial blood flow in cirrhosis. If possible, ULTRASONIC examination should be supplemented with elastography, allowing to estimate the elasticity of the body, as well as his Skovorodino.
Interpretation of the obtained data
Ultrasound can detect signs of cirrhosis of the liver:
- the increase in liver size, as a rule, at the expense of the left lobe (in the early stages of the pathological process), while the ultrasound showed reduction of the right lobe;
- reducing the size of the body (in the stage of decompensation of cirrhosis);
- the lower edge of the liver rounded;
- the outer contours on uneven;
- the structure of the liver is heterogeneous (this symptom can be determine by the availability of regeneration sites);
- hepatic echostructure increased, which is associated with the replacement of normal tissue with connective tissue and development of secondary fatty infiltration (this feature is characteristic of first two stages of cirrhosis);
- reduced echogenicity of the liver (can be seen in the last stage of cirrhosis, which is associated with atrophy of the organ, the presence of nodes of regeneration and fibrous tissue).
It is important to note that the development of cirrhosis there are several stages, with echographically looks all different. The initial stage of this disease characterized by the presence of isolated large areas of increased signal in the liver, the structure of the spleen is homogeneous.
Shaped cirrhosis of the liver looks like a mosaic pattern, with vascular pattern changes. Small veins of the portal system is not visualized, and the dilated portal vein. Its walls are more dense than normal. At this stage, a visible vascular pattern on the periphery of the body (so-called collateral circulation).
At this time the ultrasound shows the spleen is a small education of higher density. Splenic Vienna expanded and crimped in the region of the gate.
The accuracy of cirrhosis of the liver according to ultrasound appreciate the sonographic presence of the following symptoms: if you have three direct or two direct and two indirect basis, then establish cirrhosis.
Direct and indirect symptoms of cirrhosis
Direct signs include:
- increase or decrease the size of the liver (this symptom depends on the stage of the disease);
- the uneven contours of the body (often at the expense of the regeneration sites);
- changes of hepatic echostructure (decrease or increase);
- reduction of elasticity and sound conductivity (it is better to determine if elastography liver).
Indirect symptoms of cirrhosis can be seen in the occurrence of portal hypertension. This pathological condition is characterized by the expansion of the splenic vein more than ten millimeters, and veins of the port fifteen. When Doppler can determine the increase in speed performance in these veins.
It should be said that the literature data are contradictory regarding changes in arterial hepatic blood flow. It is known that the resistance index by ultrasound of the hepatic artery in patients with cirrhosis may be increased or conversely, lowered. Thus, so far undefined factors, which may affect the regional circulation in this pathology.
Indirect signs of cirrhosis include:
- the increase in spleen size (splenomegaly), this symptom can be determine 70% of patients with cirrhosis;
- the increase in diameter of the splenic and portal veins;
- free fluid in the peritoneal cavity (ascites).
In conclusion, I would like to emphasize that a diagnosis of cirrhosis of the liver should not be installed only after the ultrasound. Diagnosis must be comprehensive, including medical history and patient complaints, laboratory data, results obtained with other diagnostic techniques. The final method is a targeted liver biopsy under ULTRASOUND with subsequent histological verification of the diagnosis.